A recent review (Clin Gastroenterol Hepatol 2014; 12: 1964-72) provides useful advice on testing for bacterial overgrowth and explains the limitations/obstacles in determining whether bacterial overgrowth is present.
- Preparation: avoid antibiotics for 4 weeks prior to testing, avoid bismuth for 2-4 weeks, avoid probiotics for 2-3 weeks before testing, avoid consumption of non absorbable carbohydrates (eg. pasta, bread, fiber cereal, beans) the night prior
- Glucose substrate for hydrogen breath testing is likely most suitable. 50 g in 250 mL. Check baseline and then every 15 minutes over 120 minute testing interval. Positive study: increase of 12 ppm (or more) over baseline and/or baseline >20 ppm (if proper test conditions)
- Glucose breath test (GBT): sensitivity 20-93%, specificity 30-86%. False-positive results can occur with rapid small-bowel transit. GBT may not detect distal small bowel bacterial overgrowth. Lactulose breath test (LBT) generally has lower specificity.
- If breath testing is not available, small-bowel aspiration for quantitative culture is a reasonable consideration (challenging methodology). Alternatively, a trial of empiric antibiotics may be considered if pretest probability is high.
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